That atherosclerosis is a metabolic disorder has been known for centuries. The “gruel” or “athere” from which the name of an “atheroma” is derived was demonstrated to be a mixture of cholesterol and many other fats including triglycerides (1). John Hunter in his seminal observations on angina pectoris a century later reported that persons with disposition to stress, high arterial pressure and smoking were more prone to have angina and sudden cardiac death (2). Conglomeration of hypertension, hyperglycaemia and hyperuricaemia [an association with raised triglycerides and low high density lipoprotein (HDL) cholesterol has been clearly demonstrated] is known to be associated with increased risk for cardiovascular events for almost a century (3). Lately, large prospective epidemiological studies from various countries have reported that many risk factors are important in pathogenesis of atherosclerotic diseases (4). The INTERHEART study demonstrated that nine common risk factors (high apolipoprotein B:[A.sub.1] ratio, smoking, diabetes, hypertension, truncal obesity, psychosocial stress, physical inactivity, low fruit and vegetables intake and low alcohol intake) explain more than 90 per cent of incident myocardial infarctions (5). All this implies that vascular atherosclerosis is a result of multiple metabolic abnormalities. Corollary to this observation, multiple risk scores have been developed to predict cardiovascular diseases, especially coronary heart disease, in asymptomatic individuals (6). These range from newly developed Framingham Risk Score in asymptomatic individuals in primary care (7) to other well established risk scores such as classical Framingham risk score, German PROCAM score, European SCORE project, British QRISK and QRISK-2 and others developed in Southern Europe, Eastern Europe, China, and Australia-New Zealand and World Health Organization (8). The US National Cholesterol Education Program (NCEP) in its 3rd Adult Treatment Panel report (ATP III) coined the term of metabolic syndrome (9) and suggested its use for identification of cardiovascular risk in subjects with normal or borderline elevated low density lipoprotein (LDL) cholesterol levels. This was not meant to be a risk prediction score but a loosely defined clinical condition with permutations of multiple metabolic abnormalities such as atherogenic dyslipidaemia (low HDL cholesterol, raised triglycerides), raised blood pressure, impaired glucose tolerance and truncal obesity.